Committee Nomination Nominator Address* Street Address Address Line 2 City ZIP / Postal Code Mobile* Home Phone* Work Number Email* I wish to nominate the following member for election to the Hurricane Go Kart Club committee.Nominee* I confirm my willingness to stand for election to the Hurricane Go Kart Club committee and declare that I am not: a) an undischarged bankrupt or a person whose affairs are under insolvency laws; b) a person convicted of an offence involving fraud or dishonesty punishable on conviction by 3 months or more imprisonment; or c) a person convicted of an offence in connection with the promotion, formation or management of a body corporate, including the duties provisions under the Act.Nominee* Address* Street Address Address Line 2 City ZIP / Postal Code Mobile* Home Phone* Work Number Email* To be valid, this form must be received no later than 7 days before the Annual General Election.Date DD slash MM slash YYYY EmailThis field is for validation purposes and should be left unchanged.